Basic Information
| Provider Information | |||||||||
| NPI: | 1235670407 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MORALES | ||||||||
| FirstName: | ANDREW | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | LMFT, APCC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 401 ROLAND WAY | ||||||||
| Address2: | SUITE 150 | ||||||||
| City: | OAKLAND | ||||||||
| State: | CA | ||||||||
| PostalCode: | 946212034 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4805808781 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 401 ROLAND WAY | ||||||||
| Address2: | SUITE 150 | ||||||||
| City: | OAKLAND | ||||||||
| State: | CA | ||||||||
| PostalCode: | 946212034 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5108393800 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/20/2017 | ||||||||
| LastUpdateDate: | 03/16/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/16/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | PCCI13791 | CA | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 106H00000X | 130732 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.